OTR Example Questions

OTR Exam Prep Question: An OTR has completed a manual muscle test of a client. Results indicate the client has Poor minus (2-/5) functional strength of the dominant upper extremity. What is the MOST EFFECTIVE method for grading an activity to improve the client’s muscular strength?

A. Increasing the number of repetitions while maintaining the same resistance B. Decreasing the resistance and increasing the number of repetitions C. Increasing the amount of time an isometric contraction is held D. Completing movements through a full arc of motion against gravity

Correct Answer: C Rationale: This client is very weak as noted in a muscle grade of Poor minus (2-/5). For clients with this amount of weakness, the most effective method for increasing strength is to increase the amount of time an isometric contraction is held. A: This grading method is best for increasing endurance. B, D: This may be too difficult for a client with Poor minus (2-/5) strength. Classification: Domain 03 Task 05 Knowledge 04 Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page: 127,362 & Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 433-434, 471-476

May 25, 2012

OTR Exam Prep Question: A client has moderate hemiplegia, dysarthria and diplopia secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient setting are collaborating to initially evaluate the client using an ecological model. Records indicate the client is a single parent of an adolescent. The client plans to return to work as a librarian.

MC Question 1: What is the FIRST step the OTR should take when evaluating this client?

A. Assess deficits related to the client’s performance skills and patterns.

B. Observe specific client factors during a typical BADL task.

C. Perform a standardized assessment of motor and process skills.

D. Identify the areas of occupation the client wants or needs to do.

Correct Answer: D

Rationale: The practitioner should begin the evaluation process by learning what the client wants or needs to do. This information can then be used to help determine the type and focus of the remainder of the evaluation.

A, B, C: These could be included as part of the initial evaluation but only after learning about the client’s wants and needs.

Classification: Domain 01 Task 01 Knowledge 01

Reference: "American Occupational Therapy Association (2008). Occupational Therapy Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational Therapy, 62(6), 649.

Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 38

MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the client’s physical abilities?

A. Augmentative communication

B. Constraint-induced movement therapy

C. Dominance retraining activities

D. Visual attention and scanning exercises

Correct Answer: B

Rationale: Constraint-induced movement therapy is a task-oriented approach to motor control acquisition. This approach focuses on facilitating use of the affected arm during activities and helping the client overcome learned nonuse.

A, C, D: These will not help the client maximize physical abilities.


Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38,793-798

MC Question 3: Which type of activity should be included as part of the INITIAL intervention to remediate the client’s motor impairment?

A. Repetitive practice of an occupational performance skill in context

B. Training on the use of adaptive equipment to support an area of occupation

C. Weight bearing through the affected upper extremity prior to an activity

D. Dominance retraining during a variety of writing and drawing tasks

Correct Answer: A

Rationale: Evidence indicates that repetitive practice of a skill in context will help with cortical map reorganization for regaining functional use of the affected extremity.

B, C, D: These are not remediation activities.


Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 793-798, 815, 576 & Gillen G. (2009). Cognitive and Perceptual Rehabilitation: Optimizing Function. St. Louis, MO: Elsevier Mosby. Pages 38-42

MC Question 4: Which assessment should be included as part of the initial evaluation and can be administered by the COTA?

A. Functional Independence Measure (FIM)

B. Bay Area Functional Performance Evaluation (BaFPE)

C. Canadian Occupational Performance Measure (COPM)

D. Allen Diagnostic Module (ADM)

Correct Answer: C

Rationale: The ecological model looks at the unique and dynamic relationship between people, environments, and occupations. The COPM is a client-centered tool that supports this model by addressing a client’s perception of their performance in areas of occupation and their satisfaction with this performance across 3 key areas: self-care, productivity and leisure skills. This is a standardized assessment that a service competent COTA could administer.

A: This tool is designed for collecting information about a client to generate group data and analyze functional outcomes in inpatient rehabilitation settings.

B, D: These tools are designed primarily for clients who have a psychiatric diagnosis or cognitive deficit.

Classification: Domain 01 Task 02 Knowledge 01 & Domain 04 Task 02 Knowledge 09

Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38, 813

OTR Exam Prep Question: Scenario: "A client has a middle finger PIP joint dislocation of the non-dominant hand 4 weeks ago. The client did not seek medical attention for the injury stating: “I just put it back in place myself and wrapped the joint for comfort until it healed.” The client now has limited ROM of the involved joint and decreased grip strength. The physician consult reads: “Increase ROM, splint as indicated.” ROM of the involved digit is as follows: A client has a middle finger PIP joint dislocation of the non-dominant hand 4 weeks ago. The client did not seek medical attention for the injury stating: “I just put it back in place myself and wrapped the joint for comfort until it healed.” The client now has limited ROM of the involved joint and decreased grip strength. The physician consult reads: “Increase ROM, splint as indicated.” ROM of the involved digit is as follows: Active ROM (extension / flexion) MCP joint = 0/75 PIP joint = 30/70 DIP joint = +15/0 Passive ROM MP= 0/85 PIP= 20/80 DIP= +35/25 The client’s primary insurance company requires copies of the initial evaluation prior to authorizing OT visits beyond the first visit. The client is concerned that wearing a splint will interfere with work activities." MC Question 1: At a minimum, what information should the OTR document to increase the likelihood of additional authorized visits? A. Five setting grip strength measurements of the involved hand B. Functional problem statements indicating the need for skilled services C. Calculation of the total active motion for each digit on the affected hand D. Expected number of times the client will need to have the splint modified

Correct Answer: B Rationale: Third-party payors typically based authorization for visits on medically necessity for skilled care based on evidence of a client’s functional limitations. A: Although the five setting grip strength measurement may indicate weakness, there is no comparison to the non-dominant hand and no indication about the impact this has on function. C: The total active motion calculations may indicate joint restriction but this alone does not indicate a functional deficit. D: Splint modification provides an indication of skilled services need, but does not address the functional limitations and additional client needs. Classification: Domain 04 Task 03 Knowledge 02 Reference: Borcherding S. (2005). Documentation Manual for Writing SOAP Notes in Occupational Therapy (2nd ed.). Thorofare, NJ: SLACK Inc. Page: 5 ______________________________________________________________ MC Question #2: Based on the information presented, which deformity BEST describes the client’s finger injury? A. Boutonniere deformity with joint stiffness

B. Swan-neck deformity with ligament laxity C. Jersey finger with ligament tightness at the DIP joint D. Mallet finger with lateral band disruption

Correct Answer: A Rationale: Boutonniere deformity is described as posturing of the digit in PIP joint flexion with DIP joint hyperextension. B, C, D: These conditions are not consistent with the client’s current active and passive ROM measurements. Classification: Domain 02 Task 01 Knowledge 01 Reference: Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Pages: 305-307 _____________________________________________________________ MC Question #3: In addition to considering the use of serial casting, which of the following splints should the OTR consider when deciding which type of splint would be MOST BENEFICIAL for the client’s middle finger? A. Dorsally-based static PIP and DIP joint extension gutter splint secured with self-adhering elastic wrap B. Volar-based static DIP joint gutter splint that permits PIP joint active motion C. Circumferential neoprene tube splint that extends the entire length of the finger D. Finger-based dynamic PIP joint extension splint extending from the MCP joint crease to the DIP joint creaseCorrect Answer: D Rationale: This splint promotes PIP joint extension while allowing DIP joint flexion. A, B, C: These splints do not adequately target the structures/joints needed to address the specific deformity. Classification: Domain 03 Task 01 Knowledge 09 Reference: Coppard BM, Lohman H. (2008). Introduction to Splinting: A Clinical-Reasoning & Problem Solving Approach (3rd ed.). St. Louis, MO: Elsevier Mosby. Pages: 260-264 ____________________________________________________________ MC Question #4: How should the OTR respond to the client’s concerns about splinting? A. Listen empathetically and remind the client that wearing the splint is temporary. B. Advise the client to avoid use of the injured hand to promote the healing process. C. Encourage full participation in daily tasks by collaborating on ways to modify typical daily activities.

D. Provide the client with a few assistive devices that require the use of only one hand.

Correct Answer: C Rationale: The OTR use a client-centered strategy to determine the client’s needs and priorities based on the client’s daily activity schedule. A, B, D: It is most important to gather information about the needs and priorities of the client prior to providing assistive devices or advice to the client. Classification: Domain 02 Task 02 Knowledge 02 Reference: "Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages:

424-425 Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Page: 19 _________________________________________________________________ MC Question #5: What type of exercise should be included as part of the client’s home program and would be MOST EFFECTIVE for facilitating lengthening of the oblique retinacular ligaments and promoting glide of the lateral bands? A. Active and passive DIP joint flexion with the PIP supported in extension B. Passive PIP joint extension with the MCP joint supported in extension C. Active PIP joint flexion with the MCP joint blocked in extension D. Composite PIP joint and DIP joint passive flexion with the MCP joint supported in extension Correct Answer: A Rationale: Active and passive ROM of the DIP joint with the PIP joint supported in extension facilitates lengthening of the oblique retinacular ligament which will help to decrease the hyperextension of the DIP joint. B, C, D: These exercises do not effectively target the structure impacted by this injury. Classification: Domain 03 Task 01 Knowledge 04 Reference: Burke S, Higgins J, McClinton M, Saunders R, Valdata L. (2006). Hand and Upper Extremity Rehabilitation: A Practical Guide (3rd ed.). St. Louis: Elsevier Churchill Livingstone. Page: 304

OTR PREP QUESTION

An OTR working in an outpatient clinic is using a 360 degree goniometer to measure client's active shoulder internal rotation. The client is sitting upright with the shoulder abducted to 90 degree and the elbow flexed to 90 degree. At the start position, the OTR places the axis of the goniometer on the olecranon process of the ulna. Where should the OTR position the movable arm of the goniometer?

Correct Answer

A: Rationale: The stationary arm should be positioned parallel to the forearm

B,D: The stationary arm should be perpendicular to the floor, which will be parallel to the midline of client's torso

C: This is the position for the movable arm when measuring other shoulder motions such as horizontal abduction and horizontal adduction

OTR Exam Prep Question: A client has moderate hemiplegia, dysarthria and diplopia secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient

setting are collaborating to initially evaluate the client using an ecological model. Records indicate the client is a single parent of an adolescent. The client plans to return to work as a librarian. - REPEAT

MC Question 1: What is the FIRST step the OTR should take when evaluating this client? A. Assess deficits related to the client’s performance skills and patterns. B. Observe specific client factors during a typical BADL task. C. Perform a standardized assessment of motor and process skills. D. Identify the areas of occupation the client wants or needs to do. MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the client’s physical abilities? A. Augmentative communication B. Constraint-induced movement therapy C. Dominance retraining activities D. Visual attention and scanning exercises MC Question 3: Which type of activity should be included as part of the INITIAL intervention to remediate the client’s motor impairment? A. Repetitive practice of an occupational performance skill in context B. Training on the use of adaptive equipment to support an area of occupation C. Weight bearing through the affected upper extremity prior to an activity D. Dominance retraining during a variety of writing and drawing tasks MC Question 4: Which assessment should be included as part of the initial evaluation and can be administered by the COTA? A. Functional Independence Measure (FIM) B. Bay Area Functional Performance Evaluation (BaFPE) C. Canadian Occupational Performance Measure (COPM) D. Allen Diagnostic Module (ADM)

MC Question 1: What is the FIRST step the OTR should take when evaluating this client? Correct Answer: D Rationale: The practitioner should begin the evaluation process by learning what the client wants or needs to do. This information can then be used to help determine the type and focus of the remainder of the evaluation. A, B, C: These could be included as part of the initial evaluation but only after learning about the client’s wants and needs. Classification: Domain 01 Task 01 Knowledge 01 Reference: "American Occupational Therapy Association (2008). Occupational Therapy Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational Therapy, 62(6), 649. Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 38 ____________________________________________________________ MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the client’s physical abilities? Correct Answer: B Rationale: Constraint-induced movement therapy is a task-oriented approach to motor control acquisition. This approach focuses on facilitating use of the affected arm during

activities and helping the client overcome learned nonuse. A, C, D: These will not help the client maximize physical abilities. Classification: Domain 02 Task 03 Knowledge 01 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38,793-798 _______________________________________________________________ MC Question 3: Which type of activity should be included as part of the INITIAL intervention to remediate the client’s motor impairment? Correct Answer: A Rationale: Evidence indicates that repetitive practice of a skill in context will help with cortical map reorganization for regaining functional use of the affected extremity. B, C, D: These are not remediation activities. Classification: Domain 03 Task 01 Knowledge 05 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 793-798, 815, 576 & Gillen G. (2009). Cognitive and Perceptual Rehabilitation: Optimizing Function. St. Louis, MO: Elsevier Mosby. Pages 38-42 _______________________________________________________________ MC Question 4: Which assessment should be included as part of the initial evaluation and can be administered by the COTA? Correct Answer: C Rationale: The ecological model looks at the unique and dynamic relationship between people, environments, and occupations. The COPM is a client-centered tool that supports this model by addressing a client’s perception of their performance in areas of occupation and their satisfaction with this performance across 3 key areas: self-care, productivity and leisure skills. This is a standardized assessment that a service competent COTA could administer. A: This tool is designed for collecting information about a client to generate group data and analyze functional outcomes in inpatient rehabilitation settings. B, D: These tools are designed primarily for clients who have a psychiatric diagnosis or cognitive deficit. Classification: Domain 01 Task 02 Knowledge 01 & Domain 04 Task 02 Knowledge 09 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38, 813

OTR Prep Question:

A 15-year-old adolescent inpatient has renal disease. The patient has been socially isolated as a consequence of the multiple medical procedures. One of the patient’s goals is to “be with other kids”. During an OT session, the patient begins to work on a simple task, but suddenly moves to a corner of the clinic to be alone, stating "the other kids can always do things better." Which intervention strategy would be MOST BENEFICIAL for meeting the patient’s emotional and social needs during task completion?

A) Have the patient engage in a simple but competitive game with just one peer.

B) Provide a group task experience with two or three peers of a similar skill level.

C) Allow the patient to find a safe place in the clinic to work alone.

D) Assist the patient to successfully complete key steps with the current task.

Correct Response: B

Classification Code: Domain 03, Task 05, Knowledge 01

Reference: Case-Smith J, O’Brien. (2010). Occupational Therapy for Children (6th ed.). St. Louis, MO: Elsevier Mosby. Page: 38-39, 409-410

Rationale: The OTR should grade the demands of the intervention to accommodate the patient’s current ability to deal with social isolation due to a chronic medical condition. This option allows the patient to participate in a social activity with peers of equal skill level in order to promote successful task completion.

Incorrect Responses:

A: Engaging the patient in a competitive game does not address current emotional needs.

C: This option does not support the patient’s goal of interacting with peers.

D: Assisting the patient to complete key steps does not address the patient’s need to socialize with peers.

OTR Exam Prep Question:

A patient who had a myocardial infarction 2 days ago is participating in Phase I of cardiac rehabilitation. Which of the following activities is CONTRAINDICATED for a patient to do during this phase of rehabilitation?

A. Ambulate from the bed to the bathroom for BADL.

B. Sit on a chair at the bathroom sink to complete grooming tasks.

C. Measure perceived exertion during personal hygiene activities.

D. Complete isometrics and gentle stretching prior to lower body dressing.

Correct Answer: D

Rationale: Isometric exercises can affect the cardiovascular system by causing a rapid and sudden increase in blood pressure. This physiological response is contraindicated during this phase of cardiac rehabilitation.

Incorrect Rationale: A, B, C: These activities are typically included in the OT intervention during phase I cardiac rehabilitation.


Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 674, 1145-1147


An inpatient sustained an incomplete cervical spinal cord injury 2 months ago. The patient’s upper extremity functional strength is Trace (1/5) on the left and Poor Minus (2-/5) on the right. The patient’s goal is to eat meals independently. Which factor MUST be considered when determining if this patient is a candidate for a mobile arm support?

A. Amount of time needed to set up the device for each use

B. Amount of upper extremity passive joint mobility

C. Type of wheelchair the patient currently uses

D. Presence of upper extremity athetoid movements

Correct response: B

Rationale: A patient must have adequate passive mobility to be able to operate the MAS.

Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 719-724

Classificaiton Code: Domain 03, Task 01, Kownledge 09

A: This should not influence the decision as to whether a patient is a candidate for using this device.

C: Mobile arm support mounts are adjustable to fit a variety of wheelchairs.

D: Athetoid movements are typically associated with lesions of the basal ganglia.

OTR Prep Question: An inpatient is diagnosed with central cord syndrome. One of the patient’s goals is to be independent with ADL when discharged to live at home. Which assessment represents a biomechanical approach that can be used as part of the evaluation to determine the patient’s progress toward this goal?

A. Upper extremity manual muscle test

B. Functional Independence Measure

C. Canadian Occupational Performance Measure

D. Structured self-care checklist

Correct Response: A

Rationale: The biomechanical approach emphasizes basic client factors related to strength, ROM, and sensation. Manual muscle testing is a means of assessing muscle strength and can be used to reflect the client’s abilities to engage in ADL at home.


Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 39, 664

Incorrect responses: B, C, D: These do not relate specifically to the biomechanical approach

OTR Prep Question:

What is the PRIMARY purpose for completing a dysphagia screening for an inpatient who had a right CVA several days ago?

A. To detect silent aspiration and identify foods that are safe for the patient to eat

B. To identify causes for aspiration and the need for referral to speech therapy

C. To observe the patient's oral motor control and determine a need for further evaluation

D. To determine the patient's tolerance to various food textures prior to requesting a modified diet

Correct Response: C

A screening is not used for diagnostics or treatment planning. A screening allows the OTR to quickly detect the presence of a deficit. It is used to determine if an in-depth evaluation is indicated.

Reference: Gutman SA, Schonfeld AB. (2009). Screening Adult Neurological Populations: A Step-by-step Instruction Manual (2nd ed.). Rockville, MD: AOTA Press. Page: 238


Incorrect Responses: A, B, D: These require an in-depth evaluation and/or a collaborative team approach

OTR Prep Question:

Which physical agent modality is MOST EFFECTIVE for reducing pain and inflammation within the first 24 to 48 hours of sustaining a soft tissue injury?

A. Fluidotherapy

B. Moist hot packs

C. Cryotherapy

D. Thermal ultrasound

Correct response: C

Rationale: Cryotherapy is the application of cold to lower tissue temperature and promote vasoconstriction. This sets up a metabolic process for decreasing inflammation and edema. The application of ice also increases the threshold for pain.

Classificaiton code: Domain 03 Task 01 Knowledge 07

References: Crepeau EB, Cohn ES, & Schell BAB. (2009). Willard & Spackman's Occupational Therapy (11th ed.). Baltimore, MD: Walters Kluwer, Lippincott, Williams & Wilkins. Page 676-677

Bracciano A. (2008). Physical Agent Modalities: Theory and Application for the Occupational Therapist. Thorofare, NJ: SLACK Inc. Pages 101-104, 112-114, 139-141

Incorrect responses: A: Fluidotherapy is a thermal modality that uses forced air that is typically heated between 105-118o Fahrenheit. This modality is not an effective PAM for cooling tissue temperatures.

B: Moist hot packs are a superficial thermal modality typically used to improve soft tissue extensibility.

D: Thermal ultrasound is considered a deep heating modality. Therapeutic effects of thermal ultrasound include increasing blood flow, improving extensibility of tendons ligaments, decreasing muscle spasms and modulating pain.

OTR Prep Question: A client who has a C7 spinal cord injury has been admitted to an inpatient rehabilitation facility and is beginning OT. One of the client’s goals is to be able to prepare

family meals. After identifying the client’s typical family mealtime routines and habits, what should the OTR do NEXT to most effectively promote progress toward the client’s goal?

A. Observe the client during a standardized meal preparation task. B. Assess current physical skills and abilities during a kitchen task. C. Discuss the lay-out and type of appliances in the client’s home kitchen. D. Provide assistive devices typically used by clients who have quadriplegia.

Correct response: B

Rationale: After identifying the client’s typical mealtime habits and routines, the OTR should conduct a screening by observing the client perform a kitchen task. This will assist the therapist to generate hypotheses regarding performance deficits.

Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page: 56

Classification code: Domain 02, Task 03, Knowledge 05

Incorrect responses: A: This stage would occur after generating hypotheses regarding performance deficits in order to quantify impairments or deficits flagged during a screening. (OBSERVATION IS FOR SCREENING)

C: This information is typically gathered during the initial interview as part of the process in identifying the client’s typical meal preparation routines and habits.

D: The OTR should collect information about the habits, routines, and environments the client is used to prior to providing assistive devices.

OTR Prep Question: A client who has cognitive and motor deficits secondary to the onset of Huntington's disease is participating in OT. One of the client's goals is to be independent with dressing. Which intervention activity is BEST to include as part of the initial intervention plan?

A. Educate the client and caregivers about methods for adapting the fasteners on the client’s clothing

B. Teach the client to use a sequenced checklist to mark off tasks as they are completed during dressing

C. Have the client practice using a button-hook and long-handled reacher when completing dressing tasks

D. Use backward chaining methods and hand-over-hand assistance to teach adapted dressing skills

Correct response: A

Rationale: HD is a disorder characterized by progressive neurodegeneration. Symptoms typically include choreo-athetoid movements and alterations in behavior and cognitive functions. A client who is in the early stages of HD would most benefit from learning techniques to compensate for motor deficits


Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby PG165,887

Incorrect responses: B, D: These cognitive strategies may be indicated in the later stages of HD. Cognitive symptoms typically are not associated with onset HD

C: These devices would not be helpful for the client due to the choreo-athetoid movements associated with HD

OTR Prep Question: During which home maintenance tasks would symptoms related to constructional apraxia be MOST EVIDENT?

A. Washing the interior sides of single pane windows

B. Using a roller brush to paint an interior wall of the home

C. Vacuuming floors in the main living area of the home

D. Following written instructions for installing curtain rods


Correct response: D

Reference: Reference: Zoltan B. (2007). Vision, Perception, and Cognition: A Manual for the Evaluation and Treatment of the Adult with Acquired Brain Injury (4th ed.). Thorofare, NJ: SLACK Inc. Pages 123-128, 184.

Rationale: Individuals who have constructional apraxia have difficulty constructing/assembling objects; as in following instructions for installing curtain rods.

Incorrect Responses: A, B, C

Rationale: These tasks require motor planning, but they do not require the detailed attention required to follow instructions for installing the curtain rods.

OTR Prep Question:

A 10-year-old child has cerebral palsy with moderate athetosis and age-appropriate cognition. The child currently requires moderate assistance with BADL. One of the child’s goals is to be more independent with dressing. The OTR plans to use a cognitive approach during a dressing session with this child. Which method exemplifies this approach?

A. Employing a top-down approach to encourage the child to problem solve when difficulties are encountered during the dressing task

B. Incorporating a bottom-up method to enable the child to learn dressing tasks in a developmentally appropriate sequence

C. Allowing the child to select preferred clothing in preparation for learning an age-appropriate dressing task

D. Adapting the child's clothing and teaching compensatory strategies to use during a dressing task

OTR Prep Question: During an initial OT interview, a patient denies frequent cocaine use and cites a recent bonus as proof that work performance is not being negatively affected by substance use. The patient reports using cocaine only when under a deadline at work or when having to entertain business clients. The patient’s account indicates a lack of insight related to which of the following performance areas?

A. Leisure-time management

B. Current values and interests

C. Interpersonal and coping skills

D. Problem-solving and ethical behavior


Correct response: C

Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical Practice (2nd ed.). Thomson Delmar. Pages: 456-457

Rationale: Based on the patient’s account, the dependence on cocaine use appears to be in direct relation to the patient’s inability to manage stress appropriately. These performance areas should be addressed by developing an intervention plan that facilitates effective interpersonal and coping skill acquisition with the goal of promoting participation in all areas of occupation.

Incorrect responses: A, B, D: Although these areas may need to be addressed during the occupational therapy intervention, they do not directly relate to the situations described by the patient in the initial interview.

OTR Prep Question: An OTR is facilitating a group for clients with polysubstance use. During the first group session, the OTR describes how trigger events and irrational thinking can lead to substance misuse. Which theoretical model does this approach exemplify? A. Cognitive-behavioral B. Psychodynamic C. Motivational D. Human occupation

Correct Response: A Rationale: The premise behind cognitive-behavioral therapy is that the individual can change their behavior (substance misuse) by first challenging their negative assumptions (cognitions) relating to trigger events. Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical Practice (2nd ed.). Thomson Delmar. Page: 453 Incorrect responses: B: The premise behind psychodynamic models is that the individual’s substance misuse has resulted from earlier psychological conflicts C: Motivational strategies encourage the individual to consider change through exploration and feedback on alternative options. D: The Model of Human Occupation emphasizes exploration, competence, and achievement as related to a client’s areas of occupation.

An OTR is completing a self-care assessment with a resident in a long term care facility. Nursing staff referred the resident to OT after observing a decline in the resident’s function following an exacerbation of COPD one month ago. Medical hx is also significant for residual cerebellar symptoms secondary to an excision of a brain tumor5 years ago. The client has Fair Plus (3+/5) functional strength of bilateral upper extremities. During the assessment, the OTR asks the resident to “pick up your shirt from the night stand”. When reaching for the shirt, the resident has to stabilize the arm to prevent reaching beyond or short of the shirt. When documenting the session what term should the OTR use to BEST describe the resident’s action?

A. Decreased motor planning

B. Generalized weakness

C. Dysmetria

D. Dysdiadochokinesia

Incorrect:

A:The resident has the ability to plan the motor components needed for picking up shirt

B:Client’s functional strength is adequate to pick up shirt w/o resulting in these movements

D:Dysdiadochokinesia is the ability to perform rapidly alternating movements. These movements are not required for picking up a shirt

Rationale: Dysmetria is a common-side effect of cerebellar dysfunction. It is characterized as overshooting or undershooting an intended target



Review this: http://www.nbcot.org/index.php?option=com_content&view=article&id=241

An OTR is evaluating the ROM of a client who has rheumatoid arthritis. Goniometric measurements of the long finger are as follows:

Long Finger

Active Motion

Extension – Flexion

(in degrees)

Passive Motion

Extension – Flexion

(in degrees)

MCP Joint 0-90 0-90

PIP Joint -50-90 0-95

DIP Joint +30-40 +30-50

What do these finding indicate?

A. Dorsal subluxation of the MCP joint

B. Rupture of the flexor digitorum superficialis tendon

C. Lengthening of the lateral slips of the extensor digitorum communis tendon

D. Rupture of the central slip of the extensor digitorum communis tendon

Correct Answer: D

Rationale: "When documenting ROM measurements, a loss of full extension is represented by a minus sign. In this case, the -50 – 90 measurement for the PIP joint indicates a loss of 50 degrees extension (extension lag) and the ability to flex the PIP joint to 90 degrees. Hyperextension is documented using the plus sign (+): +30 – 40 degrees of DIP joint motion indicates there is 30 degrees of hyperextension and the joint is able to flex from 30 degrees of hyperextension to 40 degrees of flexion. These ROM measurements indicate a boutonniere deformity. This is characterized by flexion of the PIP joint and hyperextension of the DIP joint. It is typically caused by rupture or lengthening of the central slip of the extensor digitorum communis tendon.

Incorrect Rationale: A: Dorsal subluxation of the MCP joint is not typically associated with the deformity described.

B: Rupture of the flexor digitorum superficialis tendon may result in a swan neck deformity

C: Lengthening of the lateral slips of the extensor digitorum communis tendon results in a swan neck deformity


References: "Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 961-963

Cooper C. (ed.) (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Pages: 82, 305-307"

OTR Exam Prep Question: An OTR is teaching joint protection strategies to a client recently diagnosed with rheumatoid arthritis. The client enjoys cooking large family meals but pain in the MCP joints and wrist are interfering with the ability to cut meats and vegetables. In addition to recommending the use of an adapted cutting board, which type of knife would be beneficial for the client to use?

A. Serrated knife with finger contoured handle

B. Universal cuff attachment for standard slicing knife

C. Wheel configured knife with non-slip padded grip

D. Carving knife with handle set at 90 degree angle

Correct Answer: D

Rationale: This type of grip minimizes ulnar forces against the MCP joints during cutting.

Incorrect Rationale: A, B, C: These options will not reduce ulnar-directed forces against the MCP joints when cutting.


References: "Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1222-1225 Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 973-975."

OTR Exam Prep Question: A client had a repair of the median nerve on the dominant upper extremity after sustaining a work-related laceration of the wrist 6 weeks ago. The client has been undergoing rehabilitation and resumed light work as a warehouse stocker several days ago. During a follow-up appointment, the OTR observes several blisters on the client’s index finger. What INITIAL action should the OTR take based on this observation?

A. Advise the client to file an incident report with the employer B. Teach the client protective sensory re-education strategies

C. Contact the case manager to modify the client’s job tasks

D. Recommend strategies for minimizing the use of the index finger

Correct Answer: B

Rationale: It is important for the client to learn visual compensation techniques to reduce secondary injury or trauma due to the loss of sensation. Incorrect Rationale: A: The client’s blisters may not be due to a work-related injury. C, D: The client should continue with daily routines using visual compensation and other protective sensory re-education techniques. Classification Code: Domain 03 Task 05 Knowledge 05

References: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 848 Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Page 242-243

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